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Intensity-modulated radiotherapy for resected mesothelioma: the Duke experience.

Publication ,  Journal Article
Miles, EF; Larrier, NA; Kelsey, CR; Hubbs, JL; Ma, J; Yoo, S; Marks, LB
Published in: Int J Radiat Oncol Biol Phys
July 15, 2008

PURPOSE: To assess the safety and efficacy of intensity-modulated radiotherapy (IMRT) after extrapleural pneumonectomy for malignant pleural mesothelioma. METHODS AND MATERIALS: Thirteen patients underwent IMRT after extrapleural pneumonectomy between July 2005 and February 2007 at Duke University Medical Center. The clinical target volume was defined as the entire ipsilateral hemithorax, chest wall incisions, including drain sites, and involved nodal stations. The dose prescribed to the planning target volume was 40-55 Gy (median, 45). Toxicity was graded using the modified Common Toxicity Criteria, and the lung dosimetric parameters from the subgroups with and without pneumonitis were compared. Local control and survival were assessed. RESULTS: The median follow-up after IMRT was 9.5 months. Of the 13 patients, 3 (23%) developed Grade 2 or greater acute pulmonary toxicity (during or within 30 days of IMRT). The median dosimetric parameters for those with and without symptomatic pneumonitis were a mean lung dose (MLD) of 7.9 vs. 7.5 Gy (p = 0.40), percentage of lung volume receiving 20 Gy (V(20)) of 0.2% vs. 2.3% (p = 0.51), and percentage of lung volume receiving 5 Gy (V(20)) of 92% vs. 66% (p = 0.36). One patient died of fatal pulmonary toxicity. This patient received a greater MLD (11.4 vs. 7.6 Gy) and had a greater V(20) (6.9% vs. 1.9%), and V(5) (92% vs. 66%) compared with the median of those without fatal pulmonary toxicity. Local and/or distant failure occurred in 6 patients (46%), and 6 patients (46%) were alive without evidence of recurrence at last follow-up. CONCLUSIONS: With limited follow-up, 45-Gy IMRT provides reasonable local control for mesothelioma after extrapleural pneumonectomy. However, treatment-related pulmonary toxicity remains a significant concern. Care should be taken to minimize the dose to the remaining lung to achieve an acceptable therapeutic ratio.

Duke Scholars

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

July 15, 2008

Volume

71

Issue

4

Start / End Page

1143 / 1150

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Radiotherapy, Conformal
  • Radiotherapy, Adjuvant
  • Pneumonectomy
  • Pleural Neoplasms
  • Oncology & Carcinogenesis
  • Middle Aged
  • Mesothelioma
  • Male
  • Humans
 

Citation

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MLA
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Miles, E. F., Larrier, N. A., Kelsey, C. R., Hubbs, J. L., Ma, J., Yoo, S., & Marks, L. B. (2008). Intensity-modulated radiotherapy for resected mesothelioma: the Duke experience. Int J Radiat Oncol Biol Phys, 71(4), 1143–1150. https://doi.org/10.1016/j.ijrobp.2007.11.011
Miles, Edward F., Nicole A. Larrier, Christopher R. Kelsey, Jessica L. Hubbs, Jinli Ma, Sua Yoo, and Lawrence B. Marks. “Intensity-modulated radiotherapy for resected mesothelioma: the Duke experience.Int J Radiat Oncol Biol Phys 71, no. 4 (July 15, 2008): 1143–50. https://doi.org/10.1016/j.ijrobp.2007.11.011.
Miles EF, Larrier NA, Kelsey CR, Hubbs JL, Ma J, Yoo S, et al. Intensity-modulated radiotherapy for resected mesothelioma: the Duke experience. Int J Radiat Oncol Biol Phys. 2008 Jul 15;71(4):1143–50.
Miles, Edward F., et al. “Intensity-modulated radiotherapy for resected mesothelioma: the Duke experience.Int J Radiat Oncol Biol Phys, vol. 71, no. 4, July 2008, pp. 1143–50. Pubmed, doi:10.1016/j.ijrobp.2007.11.011.
Miles EF, Larrier NA, Kelsey CR, Hubbs JL, Ma J, Yoo S, Marks LB. Intensity-modulated radiotherapy for resected mesothelioma: the Duke experience. Int J Radiat Oncol Biol Phys. 2008 Jul 15;71(4):1143–1150.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

July 15, 2008

Volume

71

Issue

4

Start / End Page

1143 / 1150

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Radiotherapy, Conformal
  • Radiotherapy, Adjuvant
  • Pneumonectomy
  • Pleural Neoplasms
  • Oncology & Carcinogenesis
  • Middle Aged
  • Mesothelioma
  • Male
  • Humans